Building,Engaging, and Sustaining a Continuum of Care From Harm Reduction to Recovery Support: The Rutgers Alcohol and Other Drug Assistance Program

Since 1983, the focus of the Rutgers Alcohol and Other Drug Assistance Program (ADAP) has been developing policies, training staff to identify students at risk, developing and implementing evidence-based screening and brief interventions, providing short-term counseling by professionals trained in alcohol and other drug abuse to assist students beyond brief interventions, identifying effective treatment for college students, developing a campus recovery program, on-campus recovery housing, and other supports for students in recovery. This article presents a case study of the Rutgers ADAP program, of building and sustaining a program committed to engaging students in both evidence-based risk reduction interventions and an on-campus recovery community given their stage of change and motivation to make changes. Historical milestones are described as part of a creative model for intervention. We identify the challenges of integrating substance abuse recovery into campus mental health programs, and of integrating recovery into other university communities.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

Screening and brief intervention for alcohol problems in a university student health clinic

The purposes of this study were (1) to determine whether a university student health center (SHC) is a feasible location to introduce a campus-based screening and brief intervention (SBI) program for alcohol and (2) to determine whether the patients seen in the SHC differ in terms of the prevalence and severity of alcohol-related problems compared with students reported by emergency department programs. The authors used motivational interview techniques to counsel subjects from a convenience sample of patients waiting for medical treatment in the SHC who had screened positive with the Alcohol Use Disorders Identification Test (AUDIT). The authors interviewed patients again after 3 months. Seventy-five percent of eligible students participated. Sixty percent screened positive and received an intervention. The authors contacted 66 students (51.2%) again after 3 months. Seventy-five percent of students interviewed again after 3 months reported that SBI was helpful, 92% found the information clear, and 90% thought that the SHC was a good place to learn this information.     

Teaching Note—Implementation of Online Client Simulation to Train and Assess Screening and Brief Intervention Skills

Given the workforce shortage of adequately trained behavioral health professionals, schools of social work are ideally positioned to teach empirically supported treatments for preventing and reducing substance use, specifically, screening and brief interventions. Traditionally, opportunities to practice screening and brief intervention skills occur in classes and field placements; however, these opportunities are limited by class time, placement setting, and multiple demands placed on field instructors. Online client simulation has potential to address these limitations as an asynchronous training and assessment tool. This article details the integration of online interactive client simulation technology in advanced-level master of social work curricula. Drawing on longitudinal pre- and postdata, we present a preliminary analysis of changes in students’ screening and brief intervention skills.     

A Child‐inclusive Family Intervention in a Community Adult Mental Health Service

In this paper we describe an intervention that focuses on the needs of children in families where a parent has a mental illness and attends a community adult mental health setting. After a brief outline of the literature, we present a family approach that includes children and young people, their parents and grandparents. Case studies then illustrate the work as a ‘best practice’ for parents who are clients in community adult mental health services.     

Pediatricians could help SUD workforce by using SBIRT

Most studies on the use of screening, brief intervention and referral to treatment (SBIRT), a primary care model for screening and prevention of substance use, in adolescents have looked only at outcomes related to substance use. But SBIRT can also affect use of medical services, as well as comorbidities. Researchers found that SBIRT does reduce psychiatry visits, mental health diagnoses and chronic conditions at one and three years following the intervention. Ultimately, providing SBIRT in primary care may reduce utilization in other areas of health care later on, researchers write in the May issue of Pediatrics.     

Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

“We don't want to talk about that”: Overcoming barriers to rural aging research and interventions on sensitive topics

Geographical, economic, social and cultural barriers to accessing services in rural areas are widely reported. Less widely discussed are dilemmas posed by individual and community reluctance to address sensitive health issues. This article, focusing on the highly sensitive area of mental health, and employing a participatory action approach, describes the natural history of a project, the Mental Health and Aging Initiative (MHAI) to enhance awareness of mental health issues in rural Kentucky-Appalachian communities and overcome the reluctance of individuals in these communities to seek assistance. Funded by the United States Department of Agriculture (USDA), MHAI involved an educational intervention to improve knowledge about mental health and aging in rural Appalachian counties. The need to overcome significant community reluctance to engage in discussion of mental health resulted in significant modification of the protocol. The intervention was grounded in recognition of four key aspects of the local situation: (1) the need to understand the sensitivity of mental health as an element of rural culture; (2) the critical role of local community leaders as points of entry, acceptance, and action; (3) the need to overcome social stigma and reframe the topic of mental health in a more positive light; and (4) the need for methodological innovation in developing an empowering educational action plan oriented toward community-wide long-term impact. The intervention model that emerged from these considerations was based on engaging community leaders, providing educational and technical resources, and nurturing the acceptance by individual rural residents of responsibility for monitoring community mental health. This motif became a central theme in a strategy designed to facilitate culture change and acceptance of mental health as a community concern. It involved active engagement of community representatives in defining and implementing an intervention consistent with participatory action research as a means of empowering rural residents in monitoring and addressing sensitive health care issues. Given that many issues in rural health are difficult to address because of such sensitivity, the approach described is considered to have application in other contexts.     

A Two-Level Community Intervention Model for Homeless Mothers with Mental Health or Substance Abuse Disorders

ABSTRACT

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general inits applicability to other areas of practice.     

Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services

Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.     

Women Attending High-Risk Substance Abuse Clinics Versus General Obstetrics Clinics

Substance-abusing women experience burdens making attending high-risk prenatal care critical for a healthy pregnancy. Many face barriers that compromise their health by reducing access to care, delaying their first prenatal appointment. One hundred forty-one women attending a high-risk prenatal clinic were compared to a matched group from the hospital’s general obstetrics clinic. Analyses revealed that substance-abusing women with a mental illness attended prenatal care earlier than those without a mental illness. This is important because psychiatric illnesses might precipitate poor reproductive behaviors. Women with HIV also entered prenatal care earlier, which improves reproductive health. Clinicians’ roles are discussed.     

Physical Activity as a Helpful Adjunct to Substance Abuse Treatment

ABSTRACT

While limited research exists on the topic of physical activity as an adjunct to substance abuse treatment, a review of relevant multidisciplinary literature indicates a logical rationale for its potential benefits to recovery from addiction. This article provides an overview of common variables that contribute to addictive disease and summarizes the relationship of regular physical activity to improvements on many of these variables. The stages of change from the Transtheoretical Model (TTM, Prochaska & DiClemente, 1982; Prochaska & Velicer, 1997) are described in the context of effectively matching clients in substance abuse therapy to interventions that may include physical activity. Finally, important practical suggestions for implementing physical activity as a useful adjunct to substance abuse treatment are provided.     

Spiritual Interventions in Substance Abuse Treatment and Prevention

Abstract

This article reviews the recent research literature related to the use of spiritual interventions in the prevention and treatment of substance abuse. Empirical outcome studies are critically reviewed and a brief overview is given of spiritual interventions which have yet to be studied empirically. Areas for further research are delineated and philosophical and methodological issues related to the study of spiritual interventions are discussed.     

The Brief Assessment Checklists (BAC-C,BAC-A): Mental health screening measures for school-aged children and adolescents in foster,kinship, residential and adoptive care

More than half of children and young people in foster, kinship, and residential care, as well as those subsequently adopted from care, have mental health difficulties that require clinical formulation and intervention. While an increasing number of alternate care jurisdictions are instituting universal mental health screening, existing measures may not adequately screen for a range of attachment- and trauma-related mental health difficulties observed among these populations. The Brief Assessment Checklist for Children (BAC-C), and the Brief Assessment Checklist for Adolescents (BAC-A) are 20-item caregiver-report psychiatric rating scales designed to: 1. screen for and monitor clinically-meaningful mental health difficulties experienced by children and adolescents in various types of care; and 2. be safely administered and interpreted by health and social care professionals other than child and adolescent mental health clinicians. The BAC-C/A were also designed to be used as brief casework monitoring tools by foster care and adoption agencies, and for treatment monitoring in CAMHS. The BAC-C and BAC-A were derived from the Assessment Checklist for Children (ACC, 120 items) and Assessment Checklist for Adolescents (ACA, 105 items) respectively. Internal consistency of BAC-C (N = 347) and BAC-A (N = 230) scores were 0.89 and 0.87 respectively. The BAC-C/A were highly accurate in screening for clinical range ACC and ACA scores (area under the curve (AUC) ranging from 0.96 to 0.99), as well as for CBCL clinical range scores (AUCs: BAC-C = 0.89 to 0.92; BAC-A = 0.93 to 0.94). They were moderately accurate in screening for children that caregivers reported had been referred to mental health services (AUCs: BAC-C = 0.74; BAC-A = 0.79). Initial BAC-C/A psychometric properties compare favourably with that of existing screening instruments, including the Strengths and Difficulties Questionnaire and the Brief Problem Monitor (CBCL short form).     

The Seven Challenges: An Effective Treatment for Adolescents with Co-Occurring Substance Abuse and Mental Health Problems

ABSTRACT

Recent developments in the provision of the substance abuse treatment for adolescents has included a focus on age appropriate treatment with consideration for adolescents' relatively low level of motivation for treatment and high incidence of co-occurring substance use and mental health problems. This study examines 3- and 6-month substance use and mental health outcomes for youth (n = 36) participating in The Seven Challenges Program. Results indicate significant reductions in both substance use and mental-health-related measures at 3 months with all measures except substance abuse frequency continuing to improve at the most distal 6-month assessment. The Seven Challenges treatment model is presented along with a discussion of the findings.     

Women's Experience of Co-Occurring Substance Abuse and Mental Health Conditions

ABSTRACT

This study explored the relationship between gender and co-occurring substance abuse and mental health conditions among a sample of 754 consumers of behavioral health services in the southwest U.S. Logistic regression was used to determine factors that would predict women's unique experience of dual diagnosis. Women were almost seven times more likely than men in this sample to have a diagnosis of posttraumatic stress disorder in conjunction with substance abuse. Women were also significantly more likely to experience anxiety and mood disorders and to have been married. Implications of these findings for social work practice are suggested.     

Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions

At a time when there is increasing attention being given to systematically integrating the well-being of children with the goals of safety and permanence in child welfare, little is known about the psychosocial functioning of foster youth transitioning to adulthood from substitute care. This article systematically reviews 16 peer-reviewed articles and/or research reports to identify lifetime and past year prevalence rates of mental health disorders and service utilization. At ages 17 or 18, foster youth are 2 to 4 times more likely to suffer from lifetime and/or past year mental health disorders compared to transition aged youth in the general population. Findings show that mental health service use declines at ages when the prevalence rate of mental health disorders is peaking. The findings of this review suggest the need to focus future efforts in three main areas: 1) setting a common research agenda for the study of mental health and service use; 2) routine screening and empirically supported treatments; and 3) integration and planning between child and adult mental health service systems.     

The Role of Hawaiian Elders in Substance Abuse Treatment Among Asian/Pacific Islander Women

SUMMARY

The elders of a culture are often the designated transmitters of long-standing values and ways that define the unique essence of a people. Küpuna (elders) teachings are especially important to Native Hawaiians who have experienced the cumulative effects of cultural imperialism, which has taken their lands, discouraged use of their language and cultural ways, damaged their identity as a people and destroyed their sovereignty.

Modern day cultural imperialism, which universalizes the dominant group's experience and culture, renders minority groups as invisible while marginalizing them (Young, 1990). The chronic stress of this insidious form of oppression can translate into physical, mental health problems which lead to decreased life expectancy (McEwen, 1998; Schulkin, Gold & McEwen, 1998). Statistics on Hawaiians and other Asian/Pacific Islanders in Hawaiì indicate these groups have high rates of health problems and increasing rates of substance abuse (Office of Hawaiian Affairs, 1998).

This article describes the roles and Hawaiian practices of küpuna who acted as facilitators in the healing of Asian/Pacific Islander pregnant and postpartum women who participated in a culturally based substance abuse treatment program (CBSATP). The findings of a qualitative study, which examined the effectiveness of küpuna in these roles and their implications for practice are discussed.     

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.